title: Low serum citrulline concentration correlates with catheter-related bloodstream infections in children with intestinal failure.
abstract: BACKGROUND
  Serum citrulline concentration is used as a biomarker of enterocyte mass and enteral tolerance, and low serum concentrations are correlated with bacteremia in immunosuppressed adults undergoing hematopoietic stem cell transplant. The authors sought to determine if citrulline was associated with the development of catheter-related bloodstream infections (CRBSIs) in children with intestinal failure.
  
  
  METHODS
  Data were reviewed from 66 children treated in a multidisciplinary intestinal rehabilitation program, who had serum concentration citrulline measured between January 2007 and August 2009. All patients had a diagnosis of intestinal failure requiring parenteral nutrition (PN) support. Exclusion criteria included central venous catheter in situ <30 days, creatinine clearance <20 mL/minute, or a history of organ transplant/immunosuppression.
  
  
  RESULTS
  A total of 15 patients were excluded because of the above criteria. In this cohort of 51 patients, 26 (51%) developed CRBSIs. Both groups were similar in terms of gestational age, diagnosis, nutrition status, and biochemical liver function tests. The mean (± standard deviation [SD]) minimum serum citrulline concentration was significantly lower in patients who developed CRBSIs (6.7 ± 4.6 µmol/L) than in those who did not (11.3 ± 6.4 µmol/L, P = .004). Multivariate logistic regression analysis identified lower minimum serum citrulline concentration and longer central venous catheter duration as independently associated with CRBSI (P = .003 and P = .038, respectively).
  
  
  CONCLUSIONS
  Low serum citrulline concentration and longer central venous catheter time are independently associated with CRBSI in children with intestinal failure. Serum citrulline concentration may be a useful biomarker to identify patients with intestinal failure who are at high risk of developing a CRBSI.
authors.affiliation: Center for Advanced Intestinal Rehabilitation, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Hull
authors.forename: Brian A
authors.initials: BA
authors.lastname: Jones
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Bram
authors.initials: B
authors.lastname: Raphael
authors.forename: Clifford
authors.initials: C
authors.lastname: Lo
authors.forename: Tom
authors.initials: T
authors.lastname: Jaksic
authors.forename: Christopher
authors.initials: C
authors.lastname: Duggan
mesh_terms: D016470:Bacteremia / Q000097:blood* / Q000209:etiology / Q000382:microbiology; D015415:Biomarkers / Q000097:blood; D055499:Catheter-Related Infections / Q000097:blood* / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002956:Citrulline / Q000097:blood*; D003428:Cross Infection / Q000097:blood* / Q000382:microbiology; D005260:Female; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D015415:Biomarkers; D002956:Citrulline